Chapter XXI

Factors influencing health status and contact with health services

Persons with potential health hazards related to socioeconomic and psychosocial circumstances

Z55 Problems related to education and literacy
Excludes: disorders of psychological development ( F80-F89 )
Z55.0 Illiteracy and low-level literacy
Z55.1 Schooling unavailable and unattainable
Z55.2 Failed examinations
Z55.3 Underachievement in school
Z55.4 Educational maladjustment and discord with teachers and classmates
Z55.8 Other problems related to education and literacy
Inadequate teaching
Z55.9 Problem related to education and literacy, unspecified

Z56 Problems related to employment and unemployment
Excludes: occupational exposure to risk-factors ( Z57.- )
problems related to housing and economic circumstances ( Z59.- )
Z56.0 Unemployment, unspecified
Z56.1 Change of job
Z56.2 Threat of job loss
Z56.3 Stressful work schedule
Z56.4 Discord with boss and workmates
Z56.5 Uncongenial work
Difficult conditions at work
Z56.6 Other physical and mental strain related to work
Z56.7 Other and unspecified problems related to employment

Z57 Occupational exposure to risk-factors
Z57.0 Occupational exposure to noise
Z57.1 Occupational exposure to radiation
Z57.2 Occupational exposure to dust
Z57.3 Occupational exposure to other air contaminants
Z57.4 Occupational exposure to toxic agents in agriculture
Solids, liquids, gases or vapours
Z57.5 Occupational exposure to toxic agents in other industries
Solids, liquids, gases or vapours
Z57.6 Occupational exposure to extreme temperature
Z57.7 Occupational exposure to vibration
Z57.8 Occupational exposure to other risk-factors
Z57.9 Occupational exposure to unspecified risk-factor

Z58 Problems related to physical environment
Excludes: occupational exposure ( Z57.- )
Z58.0 Exposure to noise
Z58.1 Exposure to air pollution
Excludes: tobacco smoke ( Z58.7 )
Z58.2 Exposure to water pollution
Z58.3 Exposure to soil pollution
Z58.4 Exposure to radiation
Z58.5 Exposure to other pollution
Z58.6 Inadequate drinking-water supply
Excludes: effects of thirst ( T73.1 )
Z58.7 Exposure to tobacco smoke
Includes: Passive smoking
Excludes: mental and behavioural disorders due to the use of tobacco ( F17.- )
personal history of psychoactive substance abuse ( Z86.4 )
tobacco use ( Z72.0 )
Z58.8 Other problems related to physical environment
Z58.9 Problem related to physical environment, unspecified

Z59 Problems related to housing and economic circumstances
Excludes: inadequate drinking-water supply ( Z58.6 )
Z59.0 Homelessness
Z59.1 Inadequate housing
Lack of heating
Restriction of space
Technical defects in home preventing adequate care
Unsatisfactory surroundings
Excludes: problems related to physical environment ( Z58.- )
Z59.2 Discord with neighbours, lodgers and landlord
Z59.3 Problems related to living in residential institution
Boarding-school resident
Excludes: institutional upbringing ( Z62.2 )
Z59.4 Lack of adequate food
Excludes: effects of hunger ( T73.0 )
inappropriate diet or eating habits ( Z72.4 )
malnutrition ( E40-E46 )
Z59.5 Extreme poverty
Z59.6 Low income
Z59.7 Insufficient social insurance and welfare support
Z59.8 Other problems related to housing and economic circumstances
Foreclosure on loan
Isolated dwelling
Problems with creditors
Z59.9 Problem related to housing and economic circumstances, unspecified

Z60 Problems related to social environment
Z60.0 Problems of adjustment to life-cycle transitions
Adjustment to retirement [pension]
Empty nest syndrome
Z60.1 Atypical parenting situation
Problems related to a parenting situation (rearing of children) with a single parent or other than that of two cohabiting biological parents.
Z60.2 Living alone
Z60.3 Acculturation difficulty
Social transplantation
Z60.4 Social exclusion and rejection
Exclusion and rejection on the basis of personal characteristics, such as unusual physical appearance, illness or behaviour.
Excludes: target of adverse discrimination such as for racial or religious reasons ( Z60.5 )
Z60.5 Target of perceived adverse discrimination and persecution
Persecution or discrimination, perceived or real, on the basis of membership of some group (as defined by skin colour, religion, ethnic origin, etc.) rather than personal characteristics.
Excludes: social exclusion and rejection ( Z60.4 )
Z60.8 Other problems related to social environment
Z60.9 Problem related to social environment, unspecified

Z61 Problems related to negative life events in childhood
Excludes: maltreatment syndromes ( T74.- )
Z61.0 Loss of love relationship in childhood
Loss of an emotionally close relationship, such as of a parent, a sibling, a very special friend or a loved pet, by death or permanent departure or rejection.
Z61.1 Removal from home in childhood
Admission to a foster home, hospital or other institution causing psychosocial stress, or forced conscription into an activity away from home for a prolonged period.
Z61.2 Altered pattern of family relationships in childhood
Arrival of a new person into a family resulting in adverse change in child's relationships. May include new marriage by a parent or birth of a sibling.
Z61.3 Events resulting in loss of self-esteem in childhood
Events resulting in a negative self-reappraisal by the child such as failure in tasks with high personal investment; disclosure or discovery of a shameful or stigmatizing personal or family event; and other humiliating experiences.
Z61.4 Problems related to alleged sexual abuse of child by person within primary support group
Problems related to any form of physical contact or exposure between an adult member of the child's household and the child that has led to sexual arousal, whether or not the child has willingly engaged in the sexual acts (e.g. any genital contact or manipulation or deliberate exposure of breasts or genitals).
Z61.5 Problems related to alleged sexual abuse of child by person outside primary support group
Problems related to contact or attempted contact with the child's or the other person's breasts or genitals, sexual exposure in close confrontation or attempt to undress or seduce the child, by a substantially older person outside the child's family, either on the basis of this person's position or status or against the will of the child.
Z61.6 Problems related to alleged physical abuse of child
Problems related to incidents in which the child has been injured in the past by any adult in the household to a medically significant extent (e.g. fractures, marked bruising) or that involved abnormal forms of violence (e.g. hitting the child with hard or sharp implements, burning or tying up of the child).
Z61.7 Personal frightening experience in childhood
Experience carrying a threat for the child's future, such as a kidnapping, natural disaster with a threat to life, injury with a threat to self-image or security, or witnessing a severe trauma to a loved one.
Z61.8 Other negative life events in childhood
Z61.9 Negative life event in childhood, unspecified

Z62 Other problems related to upbringing
Excludes: maltreatment syndromes ( T74.- )
Z62.0 Inadequate parental supervision and control
Lack of parental knowledge of what the child is doing or where the child is; poor control; lack of concern or lack of attempted intervention when the child is in risky situations.
Z62.1 Parental overprotection
Pattern of upbringing resulting in infantilization and prevention of independent behaviour.
Z62.2 Institutional upbringing
Group foster care in which parenting responsibilities are largely taken over by some form of institution (such as residential nursery, orphanage, or children's home), or therapeutic care over a prolonged period in which the child is in a hospital, convalescent home or the like, without at least one parent living with the child.
Z62.3 Hostility towards and scapegoating of child
Negative parental behaviour specifically focused on the child as an individual, persistent over time and pervasive over several child behaviours (e.g. automatically blaming the child for any problems in the household or attributing negative characteristics to the child).
Z62.4 Emotional neglect of child
Parent talking to the child in a dismissive or insensitive way. Lack of interest in the child, of sympathy for the child's difficulties and of praise and encouragement. Irritated reaction to anxious behaviour and absence of sufficient physical comforting and emotional warmth.
Z62.5 Other problems related to neglect in upbringing
Lack of learning and play experience
Z62.6 Inappropriate parental pressure and other abnormal qualities of upbringing
Parents forcing the child to be different from the local norm, either sex-inappropriate (e.g. dressing a boy in girl's clothes), age-inappropriate (e.g. forcing a child to take on responsibilities above her or his own age) or otherwise inappropriate (e.g. pressing the child to engage in unwanted or too difficult activities).
Z62.8 Other specified problems related to upbringing
Z62.9 Problem related to upbringing, unspecified

Z63 Other problems related to primary support group, including family circumstances
Excludes: maltreatment syndromes ( T74.- )
problems related to:
· negative life events in childhood ( Z61.- )
· upbringing ( Z62.- )
Z63.0 Problems in relationship with spouse or partner
Discord between partners resulting in severe or prolonged loss of control, in generalization of hostile or critical feelings or in a persisting atmosphere of severe interpersonal violence (hitting or striking).
Z63.1 Problems in relationship with parents and in-laws
Z63.2 Inadequate family support
Z63.3 Absence of family member
Z63.4 Disappearance and death of family member
Assumed death of family member
Z63.5 Disruption of family by separation and divorce
Z63.6 Dependent relative needing care at home
Z63.7 Other stressful life events affecting family and household
Anxiety (normal) about sick person in family
Health problems within family
Ill or disturbed family member
Isolated family
Z63.8 Other specified problems related to primary support group
Family discord NOS
High expressed emotional level within family
Inadequate or distorted communication within family
Z63.9 Problem related to primary support group, unspecified

Z64 Problems related to certain psychosocial circumstances
Z64.0 Problems related to unwanted pregnancy
Excludes: supervision of high-risk pregnancy due to social problems ( Z35.7 )
Z64.1 Problems related to multiparity
Excludes: supervision of pregnancy with grand multiparity ( Z35.4 )
Z64.2 Seeking and accepting physical, nutritional and chemical interventions known to be hazardous and harmful
Excludes: substance dependence - see Alphabetical Index
Z64.3 Seeking and accepting behavioural and psychological interventions known to be hazardous and harmful
Z64.4 Discord with counsellors
Discord with:
· probation officer
· social worker

Z65 Problems related to other psychosocial circumstances
Excludes: current injury - see Alphabetical Index
Z65.0 Conviction in civil and criminal proceedings without imprisonment
Z65.1 Imprisonment and other incarceration
Z65.2 Problems related to release from prison
Z65.3 Problems related to other legal circumstances
Child custody or support proceedings
Z65.4 Victim of crime and terrorism
Victim of torture
Z65.5 Exposure to disaster, war and other hostilities
Excludes: target of perceived discrimination or persecution ( Z60.5 )
Z65.8 Other specified problems related to psychosocial circumstances
Z65.9 Problem related to unspecified psychosocial circumstances